Combination of corticosteroids and 5-aminosalicylates or corticosteroids alone for patients with moderate-severe active ulcerative colitis: A global survey of physicians' practice

Abstract

AIMTo examine treatment decisions of gastroenterologists regarding the choice of prescribing 5-aminosalycilates (5ASA) with corticosteroids (CS) versus corticosteroids alone for patients with active ulcerative colitis (UC).METHODSA cross-sectional questionnaire exploring physicians’ attitude toward 5ASA + CS combination therapy vs CS alone was developed and validated. The questionnaire was distributed to gastroenterology experts in twelve countries in five continents. Respondents’ agreement with stated treatment choices were assessed by standardized Likert scale. Background professional characteristics of respondents were analyzed for correlation with responses.RESULTSSix hundred and sixty-four questionnaires were distributed and 349 received (52.6% response rate). Of 340 eligible respondents, 221 (65%) would continue 5ASA in a patient hospitalized for intravenous CS treatment due to a moderate-severe UC flare, while 108 (32%) would stop the 5ASA (P < 0.001), and 11 (3%) are undecided. Similarly, 62% would continue 5ASA in an out-patient starting oral CS. However, only 140/340 (41%) would proactively start 5ASA in a hospitalized patient not receiving 5ASA before admission. Most (94%) physicians consider the safety profile of 5ASA as very good. Only 52% consider them inexpensive, 35% perceive them to be expensive and 12% are undecided. On multi-variable analysis, less years of practice and perception of a plausible additive mechanistic effect of 5ASA + CS were positively associated with the decision to continue 5ASA with CS.CONCLUSIONDespite the absence of data supporting its benefit, most gastroenterologists endorse combination of 5ASA + CS for patients with active moderate-to-severe UC. Randomized controlled trials are needed to assess if 5ASA confer any benefit for these patients.

No Benefit of Concomitant 5-Aminosalicylates in Patients With Ulcerative Colitis Escalated to Biologic Therapy: Pooled Analysis of Individual Participant Data From Clinical Trials

“…(6) In a survey of gastroenterologists, 65% reported they would continue 5-ASA therapy in a patient hospitalized for intravenous corticosteroids for acute severe colitis, and 62% reported they would continue 5-ASA in an outpatient being started on an oral corticosteroid, despite lack of evidence of benefit. (7) As a low-prevalence, high-cost condition, there is considerable interest in decreasing healthcare costs associated with inflammatory bowel diseases (IBD) through initiatives, such as the 'Choosing wisely' campaign that are focused on identifying and eliminating sources of low-value care. (8,9) Although 5-ASAs may be relatively inexpensive compared to biologic therapies, their cumulative use is likely to have considerable financial burden to patients, payers and healthcare agencies.…”

Increased SERPINA3 Level Is Associated with Ulcerative Colitis

“…The major pharmacological therapies for UC include corticosteroids, anti-inflammatory agents, and biologics [ 6 ]. Anti-inflammatory agents, such as 5-aminosalycerates (5-ASAs), have been the mainstay for the treatment of mild-to-moderate UC [ 7 ]. Although 5-ASAs are safe, their prolonged administration causes many side effects, such as headache, diarrhoea, nausea, interstitial nephritis, and hepatitis [ 8 , 9 ].…”

A Network Pharmacology-Based Study of the Mechanism of Renshen Baidu Powder in Treating Ulcerative Colitis

“…Current treatments for mild to moderate UC mainly contains 5-aminosalicylic acid (5-ASA) and corticosteroids (budesonide) 2,[10][11] . However, these therapies have low e cacy, and even with drug treatment, patients have a high short-term recurrence rate.…”